For Patients

Emsam (selegiline transdermal system) is used to treat major depressive disorder in adults. It is an antidepressant. Common side effects include dizziness, drowsiness, redness/irritation at the application site, tiredness, weakness, problems sleeping, constipation, and dry mouth. You may have thoughts about suicide when you first start using an antidepressant, especially if you are younger than 24 years old. Tell your doctor immediately if this occurs.

The recommended starting dose and target dose for Emsam is 6 mg/24 hours. The patch should be applied to dry, intact skin on the upper torso (below the neck and above the waist), upper thigh or the outer surface of the upper arm once every 24 hours. Many other medicines can interact with Emsam, causing serious medical problems. Tell your doctor all other prescription and over-the-counter medications and supplements you use. Emsam should be used only when prescribed during pregnancy. It is unknown if this medication passes into breast milk. Consult your doctor before breastfeeding.

Our Emsam (selegiline transdermal system) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Patient Information in Detail?

Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Remove the skin patch and get emergency medical help if you have any of these signs of dangerously high blood pressure:

Dizziness, drowsiness, redness/irritation at the application site, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Many drug and food interactions can increase this risk (See also Drug Interaction section.) Stop using selegiline and seek immediate medical attention if any of these very serious side effects occur: frequent/severe headache, fast/slow/irregular/pounding heartbeat, chest pain, neck stiffness/soreness, severe nausea/vomiting, sweating/clammy skin (sometimes with fever), enlarged pupils, sudden sensitivity to light (photophobia).

A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

SIDE EFFECTS

The premarketing development program for EMSAM (selegiline transdermal system) included selegiline exposures in patients and/or normal subjects from two different groups of studies:702 healthy subjects in clinical pharmacology/pharmacokinetics studies and 2036 exposures from patients in controlled and uncontrolled major depressive disorder clinical trials. The conditions and duration of treatment with EMSAM (selegiline transdermal system) varied and included double-blind, open-label, fixed-dose, and dose titration studies of short-term and longer-term exposures. Safety was assessed by monitoring adverse events,physical examinations, vital signs,body weights, laboratory analyses,and ECGs.

Adverse events during exposure were obtained primarily by general inquiry and
recorded by clinical investigators. In the tables and tabulations that follow,
standard COSTART terminology has been used to classify reported adverse events.
The stated frequencies of adverse events represent the proportion of individuals
who experienced,at least once,a treatment-emergent adverse event of the type
listed.An event was considered treatment-emergent if it occurred for the first
time or worsened while receiving therapy following baseline evaluation.

Adverse Findings Observed in Short-Term Placebo-Controlled Trials

Adverse Events Associated with Discontinuation of Treatment

Among 817 depressed patients who received EMSAM (selegiline transdermal system) at doses of either 3 mg/24 hours (151 patients), 6 mg/24 hours (550 patients) or 6 mg/24 hours,9 mg/24 hours,and 12 mg/24 hours (116 patients) in placebo-controlled trials of up to 8 weeks in duration, 7.1% discontinued treatment due to an adverse event as compared with 3.6% of 668 patients receiving placebo. The only adverse event associated with discontinuation, in at least 1% of EMSAM (selegiline transdermal system) -treated patients at a rate at least twice that of placebo,was application site reaction (2% EMSAM (selegiline transdermal system) vs.0% placebo).

Adverse Events Occurring at an Incidence of 2% or More Among EMSAM (selegiline transdermal system) -Treated
Patients

Table 2 enumerates adverse events that occurred at an incidence of 2% or more (rounded to the nearest percent) among 817 depressed patients who received EMSAM (selegiline transdermal system) in doses ranging from 3 to 12 mg/24 hours in placebo-controlled trials of up to 8 weeks in duration. Events included are those occurring in 2% or more of patients treated with EMSAM (selegiline transdermal system) and for which the incidence in patients treated with EMSAM (selegiline transdermal system) was greater than the incidence in placebo-treated patients.

Only one adverse event was associated with a reporting of at least 5% in the
EMSAM (selegiline transdermal system) group, and a rate at least twice
that in the placebo group,in the pool of short-term,placebo-controlled studies:
application site reactions (see Application Site Reactions, below).
In one such study which utilized higher mean doses of EMSAM (selegiline transdermal system) than that
in the entire study pool, the following events met these criteria: application
site reactions,insomnia,diarrhea,and pharyngitis.

These figures cannot be used to predict the incidence of adverse events in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators.The cited figures, however, do provide the prescribing physicians with some basis for estimating the relative contribution of drug and non-drug factors to the adverse event incidence rate in the population studied.

Application Site Reactions

In the pool of short-term, placebo-controlled major depressive disorder studies, application site reactions (ASRs) were reported in 24% of EMSAM (selegiline transdermal system) -treated patients and 12% of placebo-treated patients.Most ASRs were mild or moderate in severity. None were considered serious. ASRs led to dropout in 2% of EMSAM (selegiline transdermal system) -treated patients and no placebo-treated patients.

In one such study which utilized higher mean doses of EMSAM (selegiline transdermal system) ,ASRs were reported in 40% of EMSAM (selegiline transdermal system) -treated patients and 20% of placebo-treated patients.Most of the ASRs in this study were described as erythema and most resolved spontaneously, requiring no treatment. When treatment was administered, it most commonly consisted of dermatological preparations of corticosteroids.

Male and Female Sexual Dysfunction with MAO Inhibitors

Although changes in sexual desire,sexual performance,and sexual satisfaction often occur as manifestations of a psychiatric disorder,they may also be a consequence of pharmacologic treatment.

Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance, and satisfaction are difficult to obtain, in part because patients and physicians may be reluctant to discuss them.Accordingly,estimates of the incidence of untoward sexual experience and performance cited in product labeling are likely to underestimate their actual incidence.Table 3 shows that the incidence rates of sexual side effects in patients with major depressive disorder are comparable to the placebo rates in placebo-controlled trials.

There are no adequately designed studies
examining sexual dysfunction with EMSAM treatment.

Vital Sign Changes

EMSAM (selegiline transdermal system) and placebo groups were compared with respect to (1) mean change from baseline in vital signs (pulse, systolic blood pressure,and diastolic blood pressure),and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables.In the pool of short-term,placebo-controlled major depressive disorder studies, 3.0% of EMSAM (selegiline transdermal system) -treated patients and 1.5% of placebo-treated patients experienced a low systolic blood pressure,defined as a reading less than or equal to 90 mmHg with a change from baseline of at least 20 mmHg.In one study which utilized higher mean doses of EMSAM (selegiline transdermal system) ,6.2% of EMSAM (selegiline transdermal system) -treated patients and no placebo-treated patients experienced a low standing systolic blood pressure by these criteria.

In the pool of short-term major depressive disorder trials,9.8% of EMSAM (selegiline transdermal system) -treated patients and 6.7% of placebo-treated patients experienced a notable orthostatic change in blood pressure,defined as a decrease of at least 10 mmHg in mean blood pressure with postural change.

Weight Changes

In placebo-controlled studies (6-8 weeks), the incidence of patients who experienced ≥ 5% weight gain or weight loss is shown in Table 4.

ECG Changes

Electrocardiograms (ECGs) from EMSAM (selegiline transdermal system) (N=817) and placebo (N=668) groups in controlled studies were compared with respect to (1) mean change from baseline in various ECG parameters,and (2) the incidence of patients meeting criteria for clinically significant changes from baseline in these variables.

No clinically meaningful changes in ECG parameters from baseline to final visit were observed for patients in controlled studies.

Other Events Observed During the Premarketing Evaluation of EMSAM (selegiline transdermal system)

During the premarketing assessment in major depressive disorder, EMSAM (selegiline transdermal system) was administered to 2036 patients in Phase III studies.The conditions and duration of exposure to EMSAM (selegiline transdermal system) varied and included double-blind and open-label studies.

In the tabulations that follow,reported adverse events were classified using a standard COSTART-based dictionary terminology.All reported adverse events are included except those already listed in Table 2 or elsewhere in labeling, and those events occurring in only one patient.It is important to emphasize that although the events occurred during treatment with EMSAM (selegiline transdermal system) ,they were not necessarily caused by it.

Events are further categorized by body system and listed in order of decreasing
frequency according to the following definitions: frequent adverse events are
those occurring on one or more occasions in at least 1/100 patients; infrequent
adverse events are those occurring in less than 1/100 patients but at least
1/1000 patients; rare events are those occurring in fewer than 1/1000 patients.

Drug Abuse And Dependence

Controlled Substance Class

Physical and Psychological Dependence

Several animal studies have assessed potential for abuse and/or dependence
with chronic selegiline administration.None of these studies demonstrated a
potential for selegiline abuse or dependence.

EMSAM (selegiline transdermal system) has not been systematically studied in humans for its potential for abuse, tolerance, or physical dependence.While the clinical trials did not reveal any tendency for any drug-seeking behavior,these observations were not systematic and it is not possible to predict on the basis of this limited experience the extent to which a CNS active drug will be misused, diverted, and/or abused once marketed. Consequently, patients should be evaluated carefully for a history of drug abuse,and such patients should be observed closely for signs of EMSAM (selegiline transdermal system) misuse or abuse (e.g.,development of tolerance,increases in dose,or drug-seeking behavior).